Sellar mass with suprasellar extension. Sella is enlarged, consistent with early/slow growing/longstanding lesion. Mixed signal intensity; cystic component with solid heterogeneously enhancing sella and left suprasellar component. Solid component has high T1 signal at right aspect with haemosiderin staining on gradient echo and restricted diffusion, all consistent with blood products. Solid component to left is low T1, heterogeneous T2 and enhances heterogeneously. Asymmetry of lateral ventricles with slightly dysplastic right but otherwise normal ventricular configuration and extra-axial spaces. Extra-orbital, prechiasmatic optic nerves, and chiasm are stretched and displaced around the superior aspect of the mass. Normal optic tracts and radiations. Displacement of the post-ophthalmic segments of the internal carotid arteries and anterior cerebral arteries around the mass. Normal flow voids. Taken together, this lesion is most consistent with craniopharyngioma.
Note: a T2 hyperintense, non-enhancing focus in the left frontal lobe subcortical white matter follows CSF on all sequences except on FLAIR. It has a hyperintense rim, centrally isodense to grey matter on FLAIR. This is atypical for a perivascular space or gliotic focus.
Note: spinal imaging was performed which was normal.